Provider Demographics
NPI:1871093658
Name:LOYAL CDPAP LLC
Entity type:Organization
Organization Name:LOYAL CDPAP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYABICHEVA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-646-6300
Mailing Address - Street 1:2634 OCEAN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4515
Mailing Address - Country:US
Mailing Address - Phone:718-646-6300
Mailing Address - Fax:718-646-1529
Practice Address - Street 1:2634 OCEAN AVE STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4515
Practice Address - Country:US
Practice Address - Phone:718-646-6300
Practice Address - Fax:718-646-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health